Provider Demographics
NPI:1861801151
Name:ISHERWOOD, JAMES WILLIAM III (MSW (ASW105892))
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:ISHERWOOD
Suffix:III
Gender:M
Credentials:MSW (ASW105892)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18078 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HIDDEN VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95467-8622
Mailing Address - Country:US
Mailing Address - Phone:707-355-0239
Mailing Address - Fax:
Practice Address - Street 1:18078 N SHORE DR
Practice Address - Street 2:
Practice Address - City:HIDDEN VALLEY LAKE
Practice Address - State:CA
Practice Address - Zip Code:95467-8622
Practice Address - Country:US
Practice Address - Phone:707-355-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69251101YM0800X
CA105892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health